Unsafe newborn sleep influenced by grandmas and family traditions

UB researcher to study whether cultural influences play role in new moms placing babies in unsafe sleep positions

“You go home from the hospital and your mother says, ‘Honey, I never put you to sleep that way.’ Chances are you’re going to listen to your mother.”

Deborah Raines, associate professor in the University at Buffalo School of Nursing

BUFFALO, N.Y. – When it comes to newborn sleep, mother may
not know best.

According to Deborah Raines, associate professor in the
University at Buffalo School of Nursing, family, cultural and
geographical influences may lead some mothers to place their
newborn children in unsafe sleeping positions.

Although the Safe to Sleep campaign, formerly known as Back to
Sleep, was launched in 1994 to teach mothers that infants should
always sleep on their backs, more than 3,500 sudden unexpected
infant deaths (SUID) occurred in the U.S. in 2013, according to the
Centers for Disease Control and Prevention (CDC).

“Safe sleep recommendations came out years ago but babies
are still dying,” says Raines, who specializes in neonatal
care research.

“You go home from the hospital and your mother says,
‘Honey, I never put you to sleep that way.’ Chances are
you’re going to listen to your mother.”

In a new study, “What Factors Influence Sleep Position of
Infants in the Home,” Raines is working with maternal-newborn
units at Sisters of Charity Hospital in Buffalo to interview and
survey discharged mothers.

The researchers will gather data on how newborns are being put
to sleep, who is determining the infant’s sleep practices and
how well the parents learned safe sleep recommendations.

Based on their findings, the researchers will be able to
evaluate the effectiveness of current patient education and develop
new strategies to better educate mothers and families responsible
for the infant's well-being.

For infants, sleeping on their stomach is dangerous because the
position makes it difficult for them to take in oxygen and get rid
of carbon dioxide, Raines says. When coupled with a blanket or soft
sleeping surface, they can easily begin rebreathing air from a
small pocket of bedding surrounding the nose, says Raines.

Because newborns lack the motor skills and muscle strength to
move themselves, they could end up suffocating. There is often no
evidence of struggle and no noise produced, she said.

Up until the early 1990s, parents were taught by health care
professionals to place newborns on their stomachs to prevent the
child from choking when they spit up.

It wasn’t until 1992 that the American Academy of
Pediatrics recommended that infants sleep on their backs or sides.
By 1996, the message was revised that the back was the safest.

A National Infant Sleep Position household survey found that in
1992, 87 percent of U.S. infants slept on their stomachs. By 2006,
the number had fallen to roughly 25 percent,” Raines
says.

The most common causes of SUIDs are sudden infant death syndrome
(SIDS), which is the unexplained death of a child under a year of
age, and accidental suffocation and strangulation in bed.

SIDS usually occurs overnight during sleep. According to the
National Institute of Child Health and Human Development, it is
also the most common cause of death in healthy infants after 1
month of age, and 90 percent of cases occur before 6 months of
age.

Between 1990 and 1997 the SUID rate declined by almost 50
percent, falling from 1.6 deaths per 1,000 live births to nearly
0.9 deaths per 1,000 live births. However, since 1997, the rate has
plateaued, according to data from the CDC.

While the SIDS rate has declined and is now three times lower
than it was in 1990, the rate of accidental suffocation and
strangulation in bed is steadily increasing, Raines points out.

She attributes the increase partially to weather.

In areas with extreme winter weather, such as Buffalo, infants
are at a higher risk of suffocation due to the number of extra
blankets in cribs or beds. Parents are also more likely to sleep
with their children to keep them warm, further placing newborns at
risk of suffocation, says Raines.

Raines advises that dressing infants in layers and using a sleep
sac are safer ways to keep babies warm during periods of cold
weather. Parents are encouraged to share their room but not their
bed with their child.

Cultural influences can also play a role in newborn sleep
safety. Native-American and African-American infants have a SUID
rate more than double that of white infants. Hispanic and Asian
infants have the lowest SUID rates, according to data from the
CDC.

Teaching new parents about safe sleep is a standard of care in
hospital nurseries and is a required procedure before
discharge.

During a study published last year, “An Evidence-Based
Safe Sleep Teaching Program,” Raines worked with
maternal-newborn units at Sisters of Charity Hospital to develop a
teaching program for new parents.

The study led to the creation of teaching material that is
shared with parents during the hospital stay and at discharge, and
is sent home with the family as a source of information for other
caregivers.

For new parents, Raines and the nursery nurses at Sisters of
Charity Hospital recommend the ABCs of safe sleeping: